Knee valgus deformity: indications and outcomes for a high tibial medial closing-wedge osteotomy

Abstract

IntroductionTraditionally, knee valgus deformities have been corrected through distal femur osteotomies. The advances in preoperative planning allow surgeons to understand the leading site of deformity better and, therefore, propose corrections at the appropriate anatomical location. ObjectivesThe purpose of this evaluation is to present a case of a knee valgus deformity where most of the deformity resulted from the joint and the proximal tibia. A medial closing wedge tibial osteotomy corrected the proximal tibia deformity, while a fresh osteochondral allograft aimed to improve the surface of the lateral compartment of the knee, optimizing the joint lateral convergence angle. In addition, indications, outcomes and a scoping review of the literature for closing wedge high tibial osteotomy for knee valgus deformity is reviewed. MethodsA clinical case report example of a patient with knee valgus deformity requiring closing wedge high tibial osteotomy is presented. Detailed discussion of preoperative templating, planning and surgical completion is reviewed. A systematic review of previous studies and outcomes after closing wedge high tibial osteotomy was undertaken and summarized. ResultsThe case presented demonstrates an example of a valgus knee deformity with alignment correction vis a proximal tibial ostetomy. A review of and summary of previous case reports and outcomes studies for similar pathology demonstrates a high degree of success for this surgical approach. ConclusionsClosing wedge high tibial osteotomy is a viable treatment option for knee valgus deformity with an abnormal mechanical medial proximal tibial angle (mMPTA). A thorough evaluation of joint orientation angles is necessary to appropriately address limb deformity at the specific locations(s) of significant anatomic abnormality.